|Year : 2021 | Volume
| Issue : 2 | Page : 209-214
Retrospective and prospective monitoring in post COVID-19 complications and an approach for vigilance in Post-recovery period
Devulapalli S Rao1, Yousra A Nomier1, Rayan A Ahmed1, Amal N Noureldeen2
1 Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jizan, Kingdom of Saudi Arabia
2 Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, Jizan, Kingdom of Saudi Arabia
|Date of Submission||18-Nov-2020|
|Date of Decision||18-Jan-2021|
|Date of Acceptance||08-Feb-2021|
|Date of Web Publication||27-Apr-2021|
Dr. Yousra A Nomier
Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, P. O. Box: 114, Jizan 45142
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
COVID-19 is a Severe acute respiratory syndrome (SARS-CoV-2). It threatened the whole world and considered as pandemic recently, emergencies and quarantine has been declared all over the world. Many published reviews and research articles, discussed analysis, symptoms, diagnosis, and possible ways of treatments. However, nowadays, more focus is inclined on recovered patients and the possible events faced by these patients in postrecovery period. Specialists, medical care workers are looking for unmistakable approaches to defend their life later on. It is important to have a full background on their physical and psychological status after their recovery with certain guidelines to follow-up. There is more concern, care for family and society as they might suffer from stress, depression, and stigmatization from society. Awareness programs and counseling should be recommended to bring the recovered patients to their normalcy. Surveys and cohort studies will be helpful for prognosis of the disease as well as to be ready to face the second stage of COVID-19. This article will focus on recovered COVID-19 patients, their complications, precautionary methods, and post care.
Keywords: Care, complications, post COVID-19, recovery
|How to cite this article:|
Rao DS, Nomier YA, Ahmed RA, Noureldeen AN. Retrospective and prospective monitoring in post COVID-19 complications and an approach for vigilance in Post-recovery period. J Adv Pharm Technol Res 2021;12:209-14
|How to cite this URL:|
Rao DS, Nomier YA, Ahmed RA, Noureldeen AN. Retrospective and prospective monitoring in post COVID-19 complications and an approach for vigilance in Post-recovery period. J Adv Pharm Technol Res [serial online] 2021 [cited 2022 May 22];12:209-14. Available from: https://www.japtr.org/text.asp?2021/12/2/209/314673
| Introduction|| |
Covid (CoV) is a major group of infections causing weakness beginning from influenza to greater seriousness, for example, Middle east respiratory syndrome (MERS-CoV) and Severe Acute Respiratory Condition (SARS-CoV). The normal indications of Coronavirus are fever, cough, and shortness of breath, migraine, and joint pain and some develop pneumonia. As the time passed on, new things are coming up which dawdle long after an initial COVID-19 infection. In immunodeficiency and immune compromised individuals, it may cause severe complications and in the elderly and people with chronic diseases such as cancer, diabetes, and lung diseases., It is indeed that within few weeks, COVID-19 patients will recover completely. However, other people with mild stage of the disease will suffer from severe symptoms after first recovery. Old aged people, who suffered many serious medical and comorbid stages, are highly affected nagging COVID-19 symptoms. In the post COVID-19 state, the patients develop antibodies, which prevent them from contracting the virus again. Still recovery from COVID-19 is posing so many challenges and questions on patients and physicians. However, an expectation of a ray of hope exits if few measures are employed and followed and be in a safe zone as long as the virus becomes extinct. This article emphasizes the understanding and following the measures in post-COVID-19 care to decline the complications and there by mortality rate.
| Covid-19 and Recovered Patients|| |
The Center for Disease Control and Prevention (CDC) focuses intensively on the short- and long-term health consequences of COVID-19. In addition to the largest organ affected as the lungs, there are several other organs affected. Most of the COVID-19 patients are recovering and returning to normal, while some have symptoms that persist for weeks or even months after recovery. The most common symptoms are weakness, shortness of breath, cough, joint, and chest pain. Furthermore, the long-term symptoms are difficulty in thinking and concentration (at times termed as “brain fog,” depression, muscular pain, headache, irregular fever, and palpitations. Long-term complications involving different organ systems in the body have been observed and documented. The CDC continues to review and provide updated data on these aspects, as well as clinical care Shown in the [Figure 1].
According to the World Health Organization (WHO), 601,789 people have recovered. Nowadays, researchers are trying to find some after affects which may have distinct impacts on recovered patients in the future. They found that it is so hard to manage COVID-19 extent in patients who have been recovered from COVID-19 still carry SARS-CoV-2, WHO suggested having a continuous follow-up strategies and continuous polymerase chain reaction (PCR) tests to control infection spread. For these reasons, epidemiological- and immunological-based COVID-19 studies should be applied to control any complications in the future. This will help to provide postacute care in recovered patients for protection of multiorgan damage.
Complications in post-COVID-19 recovered patients
After 2 months of recovery, patients are experiencing signs and major side effects, infected with acute and severe COVID-19. Pains, apnea with significant organ dysfunction mainly associated reported body with the lungs. A study reveals that 110 patients who were hospitalized were treated. Twelve weeks after they recovered, 74% of them were recorded to have difficulty in breathing and weariness. Away from these symptoms, 104 of them were observed to have abnormal chest X-ray with lung function.
One in six patients has major side effects, of which most of them are life-threatening. It might be due to the cytokine release syndrome (or) a cytokine storm. The inflammatory proteins called cytokines released in the blood stream, causing damage to organs such as lungs, heart, and kidneys. Initial research shows that the disease attacks multiple organs other than respiratory system with formation of blood clots and inflammation. A number of reports have been observed and showed that there were a long-term fatigue, headache, vertigo, difficulties with learning and memory along with cardiac issues. All these manifestations correlate a significant cellular-damage that this virus can cause.
COVID-19 causes organ damage depending on many factors which are already being explained whilst lungs are mostly affected.
The COVID-19 complications are as follows:
Multi–organ system involvement and clinical symptoms with SARS-CoV-2
Patients should be investigated from time to another that will help in monitoring cases in second pandemic stage. COVID-19 patients who survive may have impairment in overall health state for example in gastrointestinal tract (GIT), heart, brain, eyes, and lungs. Severe pneumonia affects alveoli in the lungs resulting in respiratory distress syndrome, but initial medical interference will help to hinder this condition in the [Figure 2] and [Figure 3].
|Figure 3: Multiple pathways of SARS-CoV-2 and its effect on different organs|
Click here to view
Organ damage caused by COVID-19
The most complication is pneumonia, which in turns affect the whole body later, leading to blood clotting and heart attack. ACE-2 facilitates the entry of SARS-CoV-2 to myocardium causing myocarditis. Interaction between the virus and ACE-2 receptors completely changes the signaling pathways leading to myocardial infarction. There is an increased proliferation of cardiac muscle, leading to formation of blood clots with necrotic lipid core rupture causing myocardial infarction. It was investigated that troponin in the heart muscle, controls the normal function of the heart when a person is infected with SARS-CoV-2. According to a study, about a third of people had blood clots and were kept in the intensive care unit (ICU). According to BMJ, a weaker immune system, or absence of antibody or no response, relapse or re-infection, inflammatory reactions, and mental factors contribute to longer-term symptoms.
COVID-19 damages the tiny air sacs in the lungs, resulting in fibrosis. Studies were performed on patients, which revealed that 3/4th of them had double pneumonia and more than half suffered with lesions. It was observed that patients after recovery still showing lung opacities, ultimately making researcher to find out the proper ways to reduce complications and spread of the infection.
COVID-19 patients suffer from neurological symptoms such as hyposmia, hypogeusia, and hypoplasia due to the disturbances in immune system. SARS-CoV-2 enters CNS through nasal route then to the olfactory bulb region of the brain. Among cases and evidences, there was a suggestion that COVID-19 infection activates cytokine storm in brain as result to immune system deterioration and finally causing nervous system deaths.
COVID-19 may enter the body through the eyes and lacrimal system as it will spread through conjunctiva in the eye. Patients may suffer from conjunctivitis, chemosis, and swelling of the conjunctiva.
GIT symptoms that are related to COVID-19 infection include nausea, vomiting, abdominal pain, and GIT bleeding in addition to sore throat, dizziness, headache, and fever.
Kidney damage is a fact that kidney contains ACE-2 receptors as COVID-19 patients showed higher levels of COVID-19 and ACE-2 binding. The entry of the virus into the kidney showed inflammation and apoptosis causing kidney injury.
Multisystem inflammatory syndrome in children
In children, multisystem inflammatory syndrome or pediatric multisystem inflammatory syndrome, was noticed with fever, stomach pain, vomiting, diarrhea, rash, headache, and confusion causing inflammation of blood vessels.,
Trouble with temper and exhaustion
Individuals who suffer from severe signs of COVID-19 often need to be admitted to ICU with some supportive measures like ventilators to breathe. This kind of experience makes a patient develop posttraumatic stress syndrome along with anxiety disorders. As observed from patients who have recovered from SARS, have developed chronic exhaustion syndrome that inferior with physical or mental activity. The same may appear for people who have had COVID-19.
Prevention is better than cure
Prevention is always better than cure, hence following below are the few points as advised by the WHO.
- Stay home and self-isolate
- Clean hands frequently
- Cover nose and mouth
- Avoid touching
- Maintain physical distancing of at least 1 m from others
- Stay away from crowds
- Use a fabric mask
- Use a medical/surgical mask
- Regularly clean and disinfect.
After being recovered from COVID-19 infection, it is important to follow certain aspects such as healthy life style and make a note of alarming signals as in the [Figure 4]., Few are explained underneath:
|Figure 4: An approach to combat complications during post COVID-19 care period|
Click here to view
Once the body is fit for physical activity, you can exercise, making everyone both mentally and physically strong. Practice Yogasana, Pranayama (breathing exercises), meditation, daily as much as health permits or as prescribed.
Making intake of nutritious food
A practice of having a nutrient and supplement rich meal regimen is needed during and after recovery. Coronavirus makes a body to explore to stress and the medicines and enfeebles the body. Thus, well-planned eating regimen loaded with organic products, vegetables, eggs, and safe poultry is essential.
After getting a negative test for COVID-19, do not dream to get back to normal life. Better, try to not overexert. Take time to adjust to older routine in a slower pace.
Playing puzzles, memory games, and exercises make one's brain normally functional.
Paying attention to warning signs and symptoms
Always approach a doctor if any issues blow-up, in post recovery, whether it is a nagging headache or a shortness of breath.
Take regular medications as per the doctor's advice and for managing comorbid conditions, if any.
Intake of adequate water
Drink sufficient amount of water and keep hydrated unless it is contraindicated. Must take immunity boosters if any.
BMJ released new guidelines in the month of August for health providers to treat long-haul patients. They need to undergo specific blood tests, referred to pulmonary rehabilitation, and to use pulse Oximeter. Few measures such as strict supervision of workplace safety, awareness programs, surveys, and PCR tests follow-up should be recommended.
It is very early to understand whether 19 vaccines have a long-term safety for COVID-19. Based on this, further research is needed. Data are available with reports that individuals who recover from COVID-19 develop antibodies that provide them with re-infection defense for some time. Most vaccines for COVID-19 are given as two regimens. In general, vaccines are formulated and produced to recognize and combat the antigens in the body's immune system. At present, two vaccines are authorized and recommended, they are Pfizer-BioNTech and Moderna's COVID-19 vaccines.
| Conclusion|| |
It has become mandatory to remember that majority of people who suffered COVID-19 recover quickly. This disease has a number of queries involved, compared to the usual respiratory virus. Hence, it is always advisable to be cautious in maintaining one's own health. Keeping in view of potentially long-lasting problems and chances of re-infection in special cases (with less immunity and elder people) of COVID-19 infection, it is foremost to follow sanitary precautions such as wearing masks, avoiding crowds, and keeping hands clean. Finally, re-building mind and muscle strength to get back to normal routine is also essential. It can be concluded that health line workers provide opportunity to educate and support people about COVID-19, involve alleviating anxiety and fear during post COVID-19 recovery period.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Carfì A, Bernabei R, Landi F, Gemelli against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603-5.
Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al
. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a Multistate Health Care Systems Network-United States, March-June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-8.
Vellingiri B, Jayaramayya K, Iyer M, Narayanasamy A, Govindasamy V, Giridharan B, et al
. COVID-19: A promising cure for the global panic. Sci Total Environ 2020;725:138277.
Balachandar V, Mahalaxmi I, Subramaniam M, Kaavya J, Senthil Kumar N, Laldinmawii G, et al
. Follow-up studies in COVID-19 recovered patients-Is it mandatory? Sci Total Environ 2020;729:139021.
Iyer M, Jayaramayya K, Subramaniam MD, Lee SB, Dayem AA, Cho SG, et al
. COVID-19: An update on diagnostic and therapeutic approaches. BMB Rep 2020;53:191-205.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al
. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.
Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al
. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:1265-73.
Yancy CW, Fonarow GC. Coronavirus disease 2019 (COVID-19) and the heart-is heart failure the next chapter? JAMA Cardiol 2020;5:1216-7.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al
. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
Khan S, Ali A, Shi H, Siddique R, Shabana , Nabi G, et al.
COVID-19: Clinical aspects and therapeutics responses. Saudi Pharm J 2020;28:1004-8.
Mitrani RD, Dabas N, Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm 2020;17:1984-90.
Salehi S, Reddy S, Gholamrezanezhad A. Long-term pulmonary consequences of coronavirus disease 2019 (COVID-19): What we know and what to expect. J Thorac Imaging 2020;35:W87-9.
Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig 2020;17:175-6.
Mathew D, Giles JR, Baxter AE, Oldridge DA, Greenplate AR, Wu JE, et al
. Deep immune profiling of COVID-19 patients reveals distinct immunotypes with therapeutic implications. Science 2020;369:eabc8511.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al
. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020;395:1033-4.
Yu HQ, Sun BQ, Fang ZF, Zhao JC, Liu XY, Li YM, et al
. Distinct features of SARS-CoV-2-specific IgA response in COVID-19 patients. Eur Respir J 2020;56:2001526.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al
. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
Capuano I, Buonanno P, Riccio E, Pisani A. Acute kidney injury in COVID-19 pandemic. Nephron 2020;144:345-6.
Pero A, Ng S, Cai D. COVID-19: A perspective from clinical neurology and neuroscience. Neuroscientist 2020;26:387-91.
Barker-Davies RM, O'Sullivan O, Senaratne KP, Baker P, Cranley M, Dharm-Datta S, et al
. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020;54:949-59.
Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic: Address mental health care to empower society. Lancet 2020;395:e37-8.
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-3.
Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance, updated October 2019. Geneva: World Health Organization; 2019 (WHO/MERS/IPC/15.1 Rev. 1; https://apps.who.int/iris/handle/10665/174652
. [Last accessed on 2020 Jan 17].
Deng SQ, Peng HJ. Characteristics of and public health responses to the coronavirus disease 2019 outbreak in China. J Clin Med 2020;9:E575.
Peng F, Tu L, Yang Y, Hu P, Wang R, Hu Q, et al
. Management and treatment of COVID-19: The Chinese experience. Can J Cardiol 2020;36:915-30.
Nomier YA, Rao DS, Suhaqi AH, Ahmed RA. Distinctive therapeutic strategies against Corona Virus-19 (COVID-19): A pharmacological review. Sys Rev Pharm 2020;11:544-61.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]